PROJECT SUMMARY/ABSTRACT Effective interventions to reduce child obesity in rural areas are greatly needed and there is a growing emphasis on multi- level community-based interventions. Multi-level community-based interventions are population-based approaches that expose entire communities to obesity prevention efforts and target change at the multi-level factors (individual, interpersonal, organizational, community, and policy) that constrain children from engaging in healthy weight behaviors in community settings. Focusing on communities to prevent child obesity requires engaging persons with first-hand knowledge of the community to ensure applicability, effectiveness, and sustainability. Evidence shows that multi-level community-based interventions promote sustainable, long-term improvements in children?s weight, but studies of this type are needed in rural areas. This R03 application proposes to use community-engaged strategies to inform the development of a rural, multi-level community-based intervention to prevent unhealthy weight gain in children aged 2-5. The study will be carried out in Vance County, a rural, low-income, and largely minority community in North Carolina with high (21%) child obesity levels. We will collect formative research data to identify the rural community?s core cultural values, needs, and goals around child obesity prevention, opportunities to intervene, and community assets to leverage in a community-based intervention. The formative data will be collected via: focus group discussions with 50 parents of children aged 2-5; in-depth, in-person, one-on-one interviews with 40 additional parents and observational audits of their homes? food and physical activity environment; one-on-one interviews with 10 leaders from community organizations that serve children and families; and direct observation of 18 child care programs and the built local food and physical activity environment. Then, using charrettes, which are in-person, group sessions facilitated by two community experts and an academic expert who are versed in community-based participatory research (CBPR), we will engage partners from the rural community and our team of academic researchers from UNC to conceptualize the design, implementation strategies, and evaluation plan for the rural, multi-level community-based intervention. This R03 planning study will lay the groundwork for a sustainable community-academic partnership going forward, whereby our research team provides training/capacity-building, monitoring, and continuous support to community partners so that they can immediately begin to integrate key health messages that emerge from this study into ongoing health promotion/education programs for parents and families in the community. Findings will also support an NIH R21 application to pilot-test the intervention for feasibility, acceptability, and potential impact. If successful, this approach could provide a model for intervening in other rural southeastern communities that are similar to Vance County in lifestyle, demographics, socio- environmental characteristics, and poor child health status.